Professor Samuel Wong Yeung-shan, director of Chinese University’s Thomas Jing Centre for Mindfulness Research and Training, said there should be more subsidised services on mindfulness under the city’s primary healthcare to offer patients more options.

He said it was difficult for beginners to learn mindfulness even if they were aware of the benefits. Private sessions were available at around HK$4,000 to HK$5,000 (US$511 to US$638) for eight classes.

“There are currently no services for mindfulness … you would need to pay for classes in mindfulness but then this is a barrier,” said Wong, who heads the university’s school of public health and primary care.

‘Listen to your inner silent scream’: Hong Kong mental health recovery stories

Mindfulness is a type of meditation involving breathing methods to help individuals become intensely aware of sensations and feelings.

Previous studies have suggested that mindfulness could be an alternative to antidepressants for people with symptoms of recurrent depression.

Chinese University’s centre, which opened in 2018, provides mindfulness training and services, and conducts research. So far, more than 24,000 people have attended classes and training offered by the centre, including free online workshops.

Wong said some NGOs or psychologists in the public health system offered free mindfulness therapy, but this service was fragmented and unsystematic.

Mindfulness services could be offered at the 18 government-backed district health centres or express stations to give people one more option for a holistic approach to caring for their health, he said.

Professor Samuel Wong, director of Chinese University’s Thomas Jing Centre for Mindfulness Research and Training, has called for authorities to make the meditation-type therapy more widely available. Photo: Jelly Tse

The district-based facilities aim to educate the public on managing their health, with plans to provide mental health assessments too.

There was heightened awareness of the need for such services following a tragic incident in June when a man allegedly stabbed two women to death in a shopping centre.

The Hospital Authority at the time said the suspect had received treatment at a public specialist outpatient clinic at Kwai Chung Hospital. He last visited the centre on March 7 and had been scheduled for a session days after the incident.

Wong also said that taking care of a patient’s mental health could help manage other chronic conditions. Past studies had shown that it could help those with depression, anxiety, insomnia and substance abuse, he added.

“A patient might have chronic diseases due to mental issues, or develop mental stress as they cannot control their chronic condition well,” he said.

Conditional discharge for more Hong Kong psychiatric patients proposed

The scholar said he hoped mindfulness could eventually be incorporated as one of the routine psychological interventions and used in counselling or rehabilitation programmes.

“Once a professional workforce and resource ecosystem related to mindfulness are established, it can be highly cost-effective, potentially helping the prevention of deterioration of common mental health problems and improve the overall mental well-being of the population,” he explained.

Stanley Chan Kam-chung, an instructor at the university’s mindfulness centre, said: “Mindfulness is training of the mind. When I focus on a certain point, I will not be led by random thoughts easily.”

He noticed a growing acceptance of the practice among Hongkongers in recent years, especially those coping with the impact of the Covid-19 pandemic, curbs on social life and separation from loved ones who emigrated.

“These stresses in life prompted them to look for ways to improve their mental health,” he said.

(From left) Jenny Fung, Professor Samuel Wong and instructor Stanley Chan practise mindfulness. Photo: Jelly Tse

Retired florist Jenny Fung, in her 60s, recalled that she was troubled by a bout of high blood pressure and became depressed when medication did not help.

She joined a mindfulness programme after her doctor recommended it. While still on medication, her blood pressure began improving after she practised mindfulness for 10 days.

“I managed to calm down and could feel my own body and my breathing,” she said.

It took her around a year, practising three times a week, to bring her blood pressure back to normal and put her depression behind her.

Perpetual fear: why discharged psychiatric patients in Hong Kong walk on eggshells

Psychiatrist Ivan Mak Wing-chit said mindfulness was a non-pharmaceutical approach to addressing mental health issues and he had recommended it to patients, including those with anxiety, insomnia and eating disorders.

He noted that some people found that their negative feelings or thoughts intensified while practising mindfulness, so it might not be for everyone.

“It is one of the tools we should keep in the ‘mental health toolbox’,” he said.

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Mind-body therapies have been shown — and are recommended in guidelines — to decrease symptoms of anxiety and depression in patients with cancer who may be at any part of the care continuum, an expert said.

With this whole-person system of care, patients can use techniques including mindfulness-based stress reduction, cognitive therapy, meditation and others to address depression and anxiety symptoms. Now that mindfulness-based interventions are now recommended in a guideline prepared by the Society for Integrative Oncology (SIO) and American Society of Clinical Oncology (ASCO) as a way to treat anxiety and depression during cancer treatment, this may allow more cancer centers to offer this as part of their multidisciplinary care.

CURE® spoke with Linda E. Carlson, Enbridge Research Chair in Psychosocial Oncology and professor in the department of oncology at Cumming School of Medicine at the University of Calgary in Canada, to learn more about the ASCO/SIO guideline that she and an expert committee prepared, why they are important for patients and how patients with cancer can advocate for themselves to obtain care related to integrative oncology.

CURE®: Why are these guidelines so important?

Carlson: We know that patients suffer high levels of anxiety and depression, quite commonly around the time of diagnosis, but also going forward through transitions in care, the end of care, trying to get back into regular life. And so anxiety and depression symptoms can haunt people for a very long time.

At the same time, there’s no really good pharmacological treatments, … and many people prefer to go non-pharmacological, more natural routes.

The integrative therapies, the mind-body therapies that are in this guideline are proven. You can see through the evidence they help decrease symptoms of anxiety and depression. And so they’re non-pharmacological alternatives for patients to help cope with these difficult symptoms.

What exactly is integrative oncology?

The definition of integrative oncology … is this idea that it’s incorporating a whole-person system of care that incorporates conventional treatments, as well as complementary therapies where appropriate to help manage symptoms throughout the continuum, from prevention through lifestyle interventions, things like exercise and nutrition, right through treatment with modalities like the mind-body therapies, natural health products, and into survivorship and even end of life.

The idea is that it’s consistent with the person’s beliefs and values. It takes these complementary therapies that have an evidence base to them, applies them throughout the whole cancer journey to improve treatment tolerance and symptom reduction.

Is integrative oncology meant for all patients regardless of disease, stage and other factors?

Absolutely. The evidence base is a bit lacking for some of the rarer forms of cancer. A lot of the research has been done on women with breast cancer. So there’s definitely some holes in the evidence that have limited the kinds of recommendations that could go into the guideline, because the guideline’s based on very strict criteria, randomized-controlled trials, etc. There have been many studies done with more diverse groups of patients, but not enough to get some of those things in the guideline.

Another side note is that just because a complementary therapy may not be included in the guideline, it doesn’t mean that it isn’t helpful or it doesn’t work. It just means there hasn’t been enough research to date. So for example, things like energy therapies or massage may still have potential, but just didn’t make it into the guideline because there hasn’t been the research done yet.

The strongest recommendation was given to mindfulness-based interventions like stress reduction, meditation and mindful movement. Can you go into more detail about what those are?

We use mindfulness-based interventions as an umbrella term to talk about, usually adaptations that stem from the mindfulness-based stress reduction program that was developed by Jon Kabat-Zinn back in the 1970s.

Mindfulness-based stress reduction has been around for about 40 years, but there’s many different takes on it, different adaptations. So there’s some that are specific for people with cancer, like mindfulness-based cancer recovery, or mindfulness-based stress reduction for breast cancer, there’s mindfulness-based cognitive therapy. But what these all have in common is they’re usually group programs, they usually meet once a week over a period of six to eight weeks.

And people are taught mindfulness meditation techniques. So usually, they practice at home for 20 minutes a day or so of meditation on the breath, on the body. And mindfulness is really this idea of bringing awareness into the present moment, non-judgmentally with kindness, self-compassion with openness. And so the meditation is training people on how to do that in a systematic way. Because often our minds are trained to be out of the present moment. We’re either reliving the past and saying, “Why me? If only this or that.” We have regrets, we get depressed or we’re worrying about the future. The mind’s going off to what if this? What if that? How am I going to cope, all the terrible things that could happen, the pressures. And so, we worry and get anxious.

Depression, regret, worry, anxiety, it’s all caused by the past and future focus. But mindfulness training is more about living in the moment. It’s easy to say, it’s a simple idea, but it’s not easy to do. So the mindfulness based intervention trains people in that capacity to be in the present moment, through sitting meditation, body scan, different kinds of awareness practices, everyday mindfulness.

Usually, they have the form of mindfulness meditation practice. And they also have mindful movement, or yoga, incorporated in them. And that is around bringing awareness into the body, learning to identify when there’s stress or tension, identifying our triggers of stress, we even get into the stories we tell ourselves and the interpretations we make and how that elevates stress. There are many components to a mindfulness-based intervention. But we do know that the studies, many of them have consistently shown that they really help people cope with anxiety and depression.

There has always been some thought that any form of mindfulness would be beneficial for patients with cancer. But why was it so important to put these into a formalized guideline?

The way the medical system works is that the guidelines drive treatment decisions, and they drive insurance reimbursement. So while many people have experienced these therapies and know they’re helpful, until we have it formalized with a recommendation from a trusted body like ASCO, like SIO, that’s the first step in really making it standard of care. In fact, it makes it almost compulsory that for cancer centers to be credited as comprehensive cancer centers, they need to include these types of therapies.

The recommendations around mindfulness-based interventions, the language is “should;” people with cancer should have access, not “may,” which is the less strong language. But they should be part of comprehensive cancer care because we know they’re helpful, and they’re less harmful than other pharmacological approaches and more useful, they’re more effective.

There’s no reason why we shouldn’t take advantage of these relatively low-cost interventions with very few side effects, little harm and make those available to everybody. Everybody who’s suffering from anxiety and depression can benefit. So this is a really important institutional step in moving more towards that idea of having them really part of standard of care.

If a patient thinks that this would be a good fit for their care, how should they bring it up to their cancer team?

I would advise patients to get a copy of those guidelines and put them on the desk the next time they go to see the oncologist and say, “How come we don’t have these programs at our cancer center? Why do I have to go to the community and seek this out and pay out of my pocket? Why isn’t this covered by my insurance?” I think we need the patients to stand up and advocate. And they can use (this guideline) as a tool, a very strong tool to help them do that.

This transcription has been edited for clarity and conciseness.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.

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Para leer este articulo en español dale click aqui. 

On a recent June day in Battle Creek, Matt Jones started his typical workday in a unique job that has grown to become an integral part of mental health providers’ teams: Peer Support Specialist. 

First on his work to-do list: Locating housing for a person with a sex crime on their criminal record. As Jones was working on that, a call came in from someone who had bed bugs and needed to get their belongings cleaned. Then, Jones needed to leave the clinic to drive two people to the methadone clinic. 

All that accomplished before 10 a.m. 

Jones, 37, was hired in February as a peer support specialist at the Battle Creek SHARE Center, a non-profit agency. (SHARE stands for Self Help Awareness & Recovery.) One of the requirements of this increasingly common position is lived experience. As in, having walked the walk.

“A peer support worker is someone with the lived experience of recovery from a mental health condition, substance use disorder, or both,” according to the federal “Value of Peers” report from the Substance Abuse and Mental Health Services Administration.

“They provide support to others experiencing similar challenges. They provide non-clinical, strengths-based support.”

For Matt Jones, his strengths as a certified peer support worker are firmly rooted in his lived experience as a formerly homeless heroin addict, who now lives as a single father after his child’s mother died of a drug overdose. That traumatic event was his turning point. He has been through drug treatment court and mental health court. And he knows he never wants to go back to such a destructive lifestyle. He says the price is too high, and some people pay with their lives.

“Everything that I’ve learned in my addiction benefits me today in this job.”

A Response to a Growing Need

Working as a peer supporter is a labor of love. Demand is high for mental health services across many agencies in Kalamazoo and Calhoun counties, and many peer supporters are ground zero – serving communities that are marginalized, diverse, and in high need. 

Integrated Services of Kalamazoo and Summit Pointe are both Certified Community Behavioral Health Clinics (CCBHC) and are required to have peer support offered as a component of care. Other agencies in the area, such as Community Healing Centers, Recovery Institute of Southwest Michigan, and Recovery Services Unlimited, employ peer workers, and each of the agencies had peer specialist positions open as of June 2023.

Peer support work began in the 1970s and research and funding mechanisms that were evolving before the COVID-19 pandemic became a more pressing conversation as the demand for mental health services increased.

Matt Jones is Peer Support and Recovery Coach for the SHARE Center, a drop-in center near downtown Battle Creek.“COVID helped people realize that isolation can be deadly,” says Detroit-based peer support provider Braunwynn Franklin, board president of the National Coalition for Mental Health Recovery and founder of 313 Network Solutions. “Our suicide rates went up. Our murder-suicides went up. People were stressed out.” 

As behavioral health moves toward recovery-oriented models of care focused on trust-building and mutual respect, peer support work can prove to be a vital part of guiding clients through their recovery, says Margaret Ziemann, research scientist with the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. 

Employer demand for peer support positions nationally grew 17-fold from 2010 to 2020. While this data highlights the increasing need, Ziemann says there is no singular database to track and count the number of peer support workers across the United States. Ziemann and several colleagues published a report in February 2023 documenting the trend.

“Expanded use of peer support providers could help mitigate adverse mental and behavioral health outcomes by increasing individuals’ retention and engagement with behavioral health treatment and improving quality of life, among other benefits,” the report states. 

The position may also go by other titles, such as peer specialists, peer recovery coaches, peer advocates, and peer recovery support specialists. The position is becoming more common as organizations are looking for innovative ways to meet mental health care needs in communities.

Almost half of the U.S. population lives in a region with a shortage of mental health care workers, according to the National Institute for Health Care Management. The COVID-19 pandemic increased rates of anxiety, depressive disorders, and trauma- and stress-related disorders.

Matt Jones is Peer Support and Recovery Coach for the SHARE Center, a drop-in center near downtown Battle Creek.Matt Jones’ behavior while in active addiction caused him to be barred from drop-in services at the SHARE Center. But the Battle Creek-based nonprofit continued to feed him and engage him in classes to help him heal. Nearly seven years into his sobriety, Jones now serves as the first certified peer support worker for the SHARE Center, giving others hope and filling a much-needed role as the community continues to deal with the mental health workforce shortage.

“It’s living by example, living a clean lifestyle. I thought we were enabling people at first, but come to find out, we’re not,” Jones says. “We’re literally providing the bare minimum of their needs – the clothing, the food, the fellowship, water. They’re even building showers.”

Stabilizing a Life Through Trust

The SHARE Center provides a mutually supportive safe space with resources for recovery for vulnerable people experiencing issues with homelessness, mental health, and/or addiction. 

As Jones does the work of connecting consumers to tangible services, he’s also having conversations that make a difference. Jones says what makes him most effective is that he’s been in the streets with the people he’s serving. It’s important for him to let people know that they are loved and supported and that the SHARE Center is not giving up on them – as the center didn’t give up on Jones.

During Jones’ toughest times as a client, the SHARE Center worked on building a trusting relationship with him while providing direct services, and that’s what kept him engaged in recovery, says the SHARE Center’s Executive Director, Robert Elchert. The organization offers case managers and recovery coaches and received grant funding to add a peer support worker.

Elchert says Jones is one of the strongest people he knows and was truly suited for the job as a peer support specialist.

“You have to be very, very strong. Like Matt. You’re dealing with your own trauma and then taking on other people’s trauma as secondary trauma,” Elchert says. “Somebody who’s in recovery for substance abuse, you’re willingly subjecting yourself to other people’s substance abuse, which could be a trigger.”

Robert Elchert is the Executive Director of the SHARE Center.The organization received a two-year grant for a peer supporter, and Jones has stayed busy providing direct support and making community referrals. Some days, he takes clients to local mental health agencies for services that range from talk therapy to medication appointments. Even with clinical services available, some of their consumers are more comfortable speaking to a peer support worker about what’s happening in their lives.

“A lot of folks we see down here don’t trust the traditional mental health system. They’ve been hurt by it. They didn’t get the help they needed,” Elchert says. “A lot of times we see that lack of trust, where we really thrive on that trust component. That’s another key difference or way that peer support fills in the gap.”

Kalamazoo-based nonprofit ASK Family Services (ASK) has used peer support models for both family services and youth services. In the case of youth, the organization hires peers aged 18-28 to serve youth with serious emotional disturbances. 

Families have access to a family support partner — a parent or caregiver of a child with developmental, mood, behavioral, or emotional challenges who have faced and overcome barriers while trying to access services for their child. Latrieva Boston, ASK director of operations, says peer service is more about personal connections and helping clients find their own voices, while a therapist is using more clinical skills.

Robert Elchert is the Executive Director of the SHARE Center.“Not only will we talk about basic needs, but the mental and emotional,” Boston says. “The therapist or case manager is looking at it from the therapeutic lens, they went to school, they’re using their clinical skills. Well, those clinical skills don’t transfer over to the peer world, because they’re sitting in a different chair.” 

Boston began her career with ASK as a family support partner, giving her first-hand experience in peer support work. Now, as a supervisor post-pandemic, she speaks with pride about the staff of family support partners and youth peer supporters she’s coaching. Many times they’re called in as part of an intensive outpatient program team, and when that level of service is no longer needed, clients will still request to keep peer support. 

“The connection that our youth and our peers have built shows that they value us to keep us in their lives for a little bit longer. For some, we have been the most stable person sitting at that table on their team because case managers and therapists, especially since the pandemic, seem to change a lot,” Boston says. “Sometimes we have been with that family through two or three therapists or case managers and we’re still the ones sitting at the table. I think that gives them [the client] a sense of security.”

Beyond the Clinical Lens

Peer support specialists can work in a variety of organizations, and may be on teams with clinical staff that include behavioral health professionals, but the specialists are not considered clinicians. However, the perspective that peers add is invaluable as part of a holistic team aiming to meet clients’ needs both individually and systemically.

“Peer workers educate their colleagues and advance the field by sharing their perspectives and experience in order to increase understanding of how practices and policies may be improved to promote wellness and resiliency,” according to SAMSHA’s “Value of Peers” report. 

“This is particularly important in mental health systems,” continues the report, “where historical oppression, violence, and discrimination present significant barriers to recovery for many people. Peer workers play vital roles in moving behavioral health professionals and systems towards recovery orientation.”

Franklin of the National Coalition for Mental Health Recovery, since 2007 has dedicated her time to working as a peer support specialist and trainer, and to advocating for the advancement of the profession nationally. She has struggled with her own mental health issues, had multiple hospitalizations, and has been on and off different medications as she navigated her mental health needs. In her experience, she says peer support allows for mutuality and empathy and allows the client to figure out what they want to pursue. This philosophy is different from the clinical approach, which generally looks for a problem to diagnose and ends with providers directing clients in how to treat a problem.

“When you go to peer support and share with them ‘OK, I’m feeling down, I’m feeling suicidal.’ They don’t immediately want to ask you, ‘Do you have a plan? Do you have a purpose?’ They don’t ask that. They ask, ‘How can I support you?’ or ‘What happened?’,” Franklin says. “When you go to a professional or a doctor, that’s the first thing they’re going to ask you: ‘Do you have a plan? Do you have means? Do you have a motive?’ And then they look at how they can fix it. But I’m a person. I’m not broken. I’m having a situation. I’m having a circumstance, but I’m not broken.” 

Peer support uses a trauma-responsive lens, says Franklin, who was recognized as the National Peer Leader of the Year at the 2023 Peerpocalypse Conference, a mental health conference focused on the peer community.

“We approach the whole thing differently because we know what we needed when we were having those situations and those challenges. That’s why it has been such a help in a lot of programs,” she says.

Tough Realities

Peer support work is rewarding, but it’s not without struggle. There’s regular secondary trauma exposure, long work hours, or being on-call, and often low wages. There’s also the risk of relapse.

Just a few weeks ago, Jones found a syringe of heroin at work. He immediately took the drugs to his boss for proper disposal. They both say that the work they do requires a great deal of trust and communication. Elchert checked in with Jones to be sure he was OK.

“There are a lot of things in place to keep me safe. I do have the open-door policy with all of my bosses. I’m not afraid to talk. There’s a reason I’ve been able to stay sober as long as I have,” Jones says.

Jones maintains a relationship with his own therapist and values the support among colleagues. Elchert says the SHARE Center offers paid time off and mental health days and encourages staff to take the time they need.

At ASK, Latrieva Boston says the organization also keeps an open-door policy so staff can talk anytime, and they offer time off, plus one day each week to work from home. The office strives to have a comforting feel, she says.

“We have potlucks. We love coffee so we have all kinds of coffee in our office. One morning, I stood at the stove making a special, strong coffee, and it only makes one cup at a time, so I stood there for an hour just making coffee while we talked about cases,” Boston says, laughing. “There’s nothing wrong with that because we’re getting work done.”

Assessment of Effective Care

At the agency level, the SHARE Center collects its own data about the work it does. The Center currently relies solely on grant funding for its peer support program and is collecting data with hopes to obtain more funding to continue the work. 

At ASK Family Services, the agency measures success through both informal satisfaction surveys with clients as well as clients’ scores on a functional assessment scale. It also uses a state survey that captures data about clients at different intervals of service. Because ASK currently relies on Medicaid funding to maintain its peer support programs, this limits whom it can serve. The organization did have grants before that allowed it to serve a wider variety of people.

Many organizations with peer support programs use grant funding, Medicaid reimbursement, or a combination of funding types to run a peer support program. But the cost of completing Medicaid documentation alone can outweigh the benefit of the low reimbursement rates, noted Clese Erikson, deputy director and lead research scientist of the Health Workforce Research Center at Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University. 

Also, the uncertainty of grant funding can also make people hesitant to accept a job with a lack of security for long-term opportunities. That, combined with the time commitment, location, and expense of peer support worker training, can steer some agencies away from pursuing such a position on staff.

“There are a lot of barriers that could potentially be eliminated for this profession. Those are other factors that come into play that prevent people from entering the field or becoming certified,” Erikson says.

Both Erikson and Ziemann say training locations, criminal history restrictions and the lack of upward mobility in the career path can make it harder to obtain diversity in the field as well. Training clinicians on how to engage peer support workers will also improve outcomes, the researchers say. 

“It’s not that you necessarily need to provide training for the peer support specialist to fit into the system as it is, but what would be helpful is if you provided training to those clinical leaders and other health professionals so that they better understood how having a peer support specialist on your team can better optimize care of your patients,” Ziemann says. 

As for Braunwynn Franklin, she is using her national platform to continue to advocate for more peer-run services, like respite. She will continue training people on “Emotional CPR” – which stands for Connecting, emPowering, and Revitalizing – a way to deepen listening skills and help instill safety for a person in crisis. The training takes some “unlearning” of typical clinical responses to “fix” a person who is having a mental health crisis through medications and hospitalizations, and instead listen closely to their needs.

Training and Certification

The average pay for a peer supporter in the Midwest region is about $16 per hour, according to the National Survey of Compensation Among Peer Support Specialists report published in 2016. 

Michigan offers a state certification for peer support specialists, and a quick glance at job listings shows most agencies are looking for staff to become certified soon after hire. The application process for training includes a written application, two professional letters of reference, and a peer-to-peer telephone interview. The state currently requires five days of online training and a $300 application fee, then applicants must pass a test to be certified.

An applicant must be at least 18 years old, have a high school diploma or GED, have a primary diagnosis of a mental health condition, and have received mental health treatment for at least one year to be certified. There’s a code of ethics to be followed and certified peer support specialists have to complete at least 32 hours of approved continuing education/training during the two-year period prior to renewal of certification.

Family and youth peer supporters have different certification training through the Association for Children’s Mental Health. There are also other recognized training and certification programs both online and in-person, as well as supplemental training that might help peer support specialists on the job. 

A Beautiful Thing

But Jones of the SHARE Center says the most important training as a peer supporter is lived experience. That, and learning to expect the unexpected.

“Don’t get into it unless you truly have the heart for it,” Jones says. “It’s the most selfless thing I’ve ever had to do in my life.”

Jones has already navigated obtaining services through systems he’s helping consumers use, but he also received training in cognitive behavioral therapy and substance abuse recovery, as well as in administering Narcan.  

“I’ve lost my freedom. I’ve lost a child. I’ve lost relationships. I haven’t been able to get a lot of those things back. There’s been things I can’t reverse. And I paid my debt to society,” Jones says. “There were courses I had to go to, but being here and helping people and living it has been the best training I’ve gotten.”

Jones says during an interview that he was looking forward to taking two people to drug rehab the next day. He was in preparations to help them get the aftercare needed to stay sober.

“Sitting down, talking to these people, and getting them into rehab, they’re all ecstatic because now there’s hope. And anytime you have hope, it’s a beautiful thing,” Jones says. 

“We didn’t come this far to only come this far.”

Photos by John Grap.
 

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MINNEAPOLIS — This month, changes go into effect impacting first responders who leave the profession using something called duty disability. That can range from a physical injury to PTSD.

A historic number of officers have left their jobs for mental health reasons in the last few years, sparking debate and prompting new legislation at the Minnesota Capitol. The impact is on those who protect and serve — first responders communities rely on and the cities who employ them.

“We want Minnesotans that keep us safe to be kept healthy,” the bill’s author Minnesota Sen. Nick Frentz, DFL-Mankato, said. “The first difference is that we’re providing 24 weeks of treatment for the men and women who keep us safe. That means cutting-edge treatment for PTSD to try to help them recover.”

Frentz says first responders would stay on the payroll during that time. And only after the treatment are they able to apply for duty disability, with the hope some will stay on the job after getting help. It also helps cities cover the cost of health insurance if someone goes out on duty disability.

“The provisions in the bill that reimburse cities and counties for the healthcare costs is a crucial plus, especially for mid-size and smaller communities where even one or two claims of 30 years of healthcare expenses can be substantial,” Frentz said.

A retired Minneapolis Police Department sergeant opposes what was passed.

“It’s gonna hurt a lot more first responders than it’s gonna help,” Chris Steward said.

Steward went out on duty disability for PTSD. He says the mental health provisions don’t go far enough or have enough safeguards.

“If they wanted to make this effective and efficient and helpful, they would have offered this mandatory treatment parameters as optional, as giving the first responders an opportunity to participate in this treatment, because a lot of them would,” Steward said.

Instead, Steward feels what was passed will only worsen the problem.

“It’s gonna force people back into the closet. It’s gonna force people to kind of suck it up and not deal with the mental health issues we’ve been trying so hard to raise awareness for,” Steward said.

He calls PTSD a lifetime injury.

“These are lifetime injuries, these are lifetime disabilities, and you will never be able to go back to the position that you left,” Steward said.

The League of Minnesota Cities, who lobbied on behalf of 855 communities, says the new law will help them.

“There is significant funding in the bill, much of which will come back to employers, but that will save taxpayer dollars at the local level when these incidents occur,” Anne Finn said.

Finn says a lot of effort went into the bill, with the goal of preventing mental injuries and then caring for those who do suffer from them.

“We know that not every person who is injured will come back to work or can, but we think that too many have left without getting the help they need to be able to even evaluate whether they want to continue in their profession,” Finn said.

While she realizes not everyone is happy with the bill, she does hope people don’t rush to judgment.

“I hope they’ll be open-minded to giving the legislation a chance. A lot of effort went into trying to get it right,” Finn said.

There have been a lot of questions about the reapplication process. PERA, which manages the fund, says some clarifications were made, but there’s no change. We have information PERA sent to members on that, along with new offsets if a person is re-employed, at the links below:

WCCO also received the following statement from PERA:

HF1234 impacts Police & Fire Plan members in four ways. First, the Bill improves access to mental health care, which stakeholder groups agree may help reduce the future number of disability benefit recipients. Second, the Bill changes the vesting for Police & Fire members to a graded 10 years vesting schedule. Thirdly, the Bill more closely aligns a disability recipient’s income (benefit plus reemployment earnings) with an active member’s income (salary net of contribution requirements) and eliminates the current workers’ compensation offset. Lastly, the Bill increases the disability benefit amount for members receiving a duty total and permanent benefit.

Jennifer Mayerle

Jennifer Mayerle happily returned to Minnesota and WCCO, where she began her career as an intern. The Emmy and Edward R. Murrow award-winning journalist joined WCCO as a reporter in May 2014. She also anchors “WCCO Saturday Morning” from 8-9 a.m.

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Districts nationwide are trying to address high numbers of student needing mental health support. What if they can enlist students as part of the solution, too?

A rural Ohio high school has done just that.

At Claymont High School in Uhrichsville, Ohio, about 55 miles south of Akron, a group of about 21 high schoolers are trained in mental health first aid. They’ve taken a six nearly hour-long courses over six weeks to learn how to help their peers who are going through a difficult time—including how to talk to students who might be having thoughts of suicide, how to connect them with a trusted adult, and how to provide them with mental health resources.

Maggie Lesiecki, a sophomore, said she’s learned how to talk to peers who are having mental health issues, without making them feel bad about it.

“Ask them how they are, listen to them—just be a friend, give them someone to talk to,” she said.

The students, who are in grades 10 to 12, are part of a larger program called Peers Uplifting Peers, or P.U.P, which helps to break down the stigma around mental health and wellness and normalize having conversations about both and seeking help when necessary.

They’re trained as dog handlers for the district’s two therapy dogs—another student-led wellness initiative.

The students take the dogs to classes to help ease the anxieties of those who may be nervous about giving a speech—or help younger students gain the confidence to read.

“With this training we are able to help our friends when they are experiencing problems in their lives,” said Cora Dotts, a freshman.

Cora’s sister, Gemma, a sophomore, is also in the program, and their mother, Heather Dotts, a science teacher at the high school, is one of two trained adult dog handlers in the district.

Weaving together support

New data from the Centers for Disease Control and Prevention released last week show that teen mental health emergency room visitsfor mental health related issues were dropping. Butschools are still struggling to find qualified mental health care professionals to help students. That’s even harder in rural areas like Uhrichsville.

Kelsi Barnhart, the school’s assistant principal, said that while the county sends a counselor to the school once a week, the counselor is unable to take new student referrals.

“Sometimes that’s frustrating—to tell a parent, ‘Right now we can’t send you to this agency,’” Barnhart said.

Teachers help where they can, Barnhart said, but they’re not substitutes for having clinical, medical help on campus. Students are also helping out, by picking up on early warning signs.

The adults stressed that students are not meant to provide counseling, and a key part of their training is to help their friends get in touch with professionals and established resources.

“They are noticing that maybe someone is having a hard day or is just sitting by themselves,” she said. “They try to be good friends, and they speak up. It’s not that they are stepping in and providing counseling. I think it’s about being a good person to everybody and setting an example: This is how we treat other people.”

Through their training, the students learn about mental health resources in the school and the community.

“These kids are high school students, [they] are on that bridge into adulthood. Many of them are also enrolled in college courses,” Heather Dotts said. “I would say these kids get to be kids—but they are also learning how to be leaders. They have learned the tools they need to support their peers who are experiencing a mental health crisis. They learn to understand the science behind these mental health challenges, and they learn how to get their peers help.”

Despite a national conversation around mental health, the context may be different in rural communities, said Bridget Britton, a behavioral health field specialist and a licensed social worker. She runs the mental health training programs for adults and teens for Tuscarawas County, in which Urichsville is located, at the Ohio State University Extension College of Food, Agricultural, and Environmental Sciences in Philadelphia, Ohio.

There’s still stigma around mental health, as in many communities. Getting to a therapist or an acute care facility can also be a challenge, since most rural areas do not have the bus and rail systems found in urban or suburban commuter communities. And in a culture where many people subscribe to a “pull yourself up by your bootstraps” ethos, it’s hard to something talk about mental health out loud, she said.

“People don’t talk about it, she said. “People don’t want to talk about it. The parents don’t want to talk about it.”

There are also financial barriers. Many rural residents work on farms, which often don’t provide workers with health insurance. And although tele-health has expanded in recent years during the pandemic, lack of reliable internet means many rural communities aren’t benefiting, she said.

Britton has trained the entire administrative team in some rural districts in mental health first aid, as well as their teens for teen-led mental health first aid.

“It fits into the prevention model, which I think is super-important,” she said. “They are really one of the first lines of defense. They are with their peers all the time. They feel most comfortable talking to their peers. Sometimes they will open up to their peers [more easily] than they would an adult or a therapist. So, if their peers are trained in saying, ‘It’s OK to not to be OK,’ that’s part of the solution.”

Helping and supporting friends

The students offered key tips on how to approach those who need assistance.

“Ask them questions, and don’t ask if they are OK,” said Chelsea TK, “Hopefully by the second time, they might say something.”

“Try to ask if they have a trusted adult they can go to about the problem,” said Cora Dotts.

Maggie, a sophomore, found herself in a tough situation last year with a friend who was struggling. The friend stopped attending classes, and at one point contemplated taking their own life, Maggie said.

She was able to talk to them and get them to talk to a professional. Her friend is in counseling and doing well today, Maggie said.

“Now that I have gone through the training I feel like I could talk to [them] a lot better,” she said.

Learning key skills beyond mental health first aid

The students said the program has also helped them develop coping skills for themselves—like taking social media breaks, finding trusted peers to talk to when they are struggling, and spending time on hobbies, like swimming, reading, gardening, and watching television.

“I have a circle of support,” Cora said. “Personally, I love to read, listen to music, and hang out with my dogs, rabbits, and horses.”

Chelsea hangs out with her friends and family. She’s also in 4-H and runs track. Gemma loves to read, play the cello, and ride horses—all great ways to de-stress, she said.

Britton said more districts are reaching out to her for training. But often, it’s still only after a tragedy happens

“I always tell them we can’t go back, we can only go forward, and that’s what we’ll do—go forward,” she said.

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Preventative Care: Mental health is just as important as physical health when it comes to preventative care. Regular mental health check-ups can help identify potential mental health issues before they become more severe. By addressing these issues early on, men can manage their mental health effectively and prevent them from escalating into more serious problems.

Improved Physical Health: Poor mental health can have negative effects on physical health. Mental health problems such as depression, anxiety, and stress can lead to physical symptoms such as headaches, digestive problems, and chronic pain. By prioritizing mental health, men can improve their overall well-being and reduce the risk of physical health problems.

Reduced Stigma: Mental health stigma is a significant barrier to seeking help for mental health issues, especially for men. However, by making mental health a routine part of men’s health care, we can reduce the stigma surrounding mental health and promote open discussions about mental health problems. This will encourage men to seek help when they experience mental health issues, leading to better outcomes and improved quality of life.

Improved Relationships: Mental health problems can affect personal relationships, which can lead to further stress and anxiety. By prioritizing mental health, men can improve their relationships with family, friends, and colleagues. This can lead to improved communication, better emotional regulation, and reduced conflict.

Increased Productivity: Mental health problems can affect work performance, leading to absenteeism, presenteeism, and reduced productivity. By prioritizing mental health, men can improve their work performance and productivity. This can lead to improved job satisfaction, career advancement, and financial stability.

In conclusion, mental health should be a routine part of every man’s health care. By prioritizing mental health, men can improve their overall well-being, reduce the risk of physical health problems, reduce stigma, improve relationships, and increase productivity. Men should seek professional help when they experience mental health issues and practice self-care strategies such as exercise, healthy eating, and stress management to maintain good mental health. Let’s promote the importance of mental health in men’s health care and break down the barriers to seeking help for mental health problems.

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Mental health refers to our emotional, psychological, and social well-being. It affects how we think, feel, and behave, and influences our ability to cope with stress, build relationships, and achieve our goals. Mental health problems are common among women, with one in five women experiencing a mental health condition in their lifetime, such as depression, anxiety, post-traumatic stress disorder, or eating disorders.

Taking care of your mental health is not a luxury, but a necessity. Here are some ways to prioritize your mental well-being as part of your self-care routine:

1. Recognize the signs of mental health problems: It’s important to be aware of the symptoms of mental health problems, such as feeling sad, anxious, or irritable, losing interest in activities, having trouble sleeping or concentrating, or experiencing physical symptoms such as headaches or fatigue. If you notice any of these signs, seek help from a mental health professional.

2. Practice self-care: Self-care is the act of taking care of your physical, emotional, and mental needs. This can include activities such as exercise, healthy eating, getting enough sleep, practicing relaxation techniques such as meditation or yoga, and engaging in hobbies or activities that bring you joy.

3. Connect with others: Social support is a key factor in mental health and well-being. Make time to connect with friends, family, or support groups, and share your feelings and experiences with them. If you’re feeling isolated, consider reaching out to a mental health professional or helpline.

4. Manage stress: Stress is a common trigger for mental health problems, and women may face unique stressors such as work-family conflict, caregiving responsibilities, or discrimination. Find ways to manage stress, such as setting realistic goals, prioritizing tasks, delegating responsibilities, and practicing relaxation techniques.

5. Seek professional help: If you’re experiencing persistent or severe mental health problems, don’t hesitate to seek help from a mental health professional. They can provide a diagnosis, treatment, and support tailored to your individual needs.

Taking care of your mental health is not selfish, but a vital part of your overall health and well-being. By prioritizing your mental health, you can improve your quality of life, enhance your relationships, and achieve your goals. Remember, you deserve to take care of yourself as much as you take care of others.

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We have built-in tools to help us stay calm during crisis

During times of upheaval, the body and brain go on “hyper-alert.” While medication can help reduce the effect of fight-or-flight chemistry, Hashem has embedded tools within the body itself to do that. There are three types of breathing patterns, for example, that once learned and practiced, can profoundly settle the nervous system. Not only should all of us spend a minute a day (ideally just before bed) practicing one or two of them, but we also should teach them to our children.

Here is an effective anti-panic attack breathing pattern: Breathe in slowly through your nose until you feel your lungs are full. Then take in one more breath through your nose. Now open your mouth and gently release the breath. Repeat as many rounds as necessary to feel settled again.

Here is the “coherent breath” pattern that enables your body and mind to function at optimal levels even when you’re under extreme stress. Use it for a couple of minutes once an hour during times of crisis and once or twice a day on a regular basis to train your system and empower yourself for times of need.

Breathe in slowly through the nose. Use a second hand on a watch to see how many seconds it takes you to inhale comfortably. Now breathe out through the nose, doing so within the same number of seconds. For example, you might inhale to a count of five and exhale to a count of five. If you prefer, there are plenty of breathing timers available to help ensure that your inhale and exhale are approximately the same duration.

Finally, here is Dr. Herbert Benson’s “Relaxation Response.” This pattern of breathing facilitates sleep and recovery. It can actually replace hours of sleep on its own, which is particularly important to know when sleep eludes us for any reason. Here’s how it’s done: Breathe in through the nose normally. Think the number “one” as you exhale through your nose. Focus all your attention on the sensations of the breath, paying close attention to how the air feels as it enters and exits your nostrils (this is very important). Continue for five to 20 minutes, or as long as necessary to experience deep relaxation.

Mind Control

Another “free tool” available literally at our fingertips and extremely useful during times of crisis is EFT (Emotional Freedom Techniques). Distressing emotions such as fear, shock, despair, grief, guilt accompany the experience of crisis. In addition to the pain they cause, these emotions continue to disrupt the nervous system, spilling toxic chemistry into our bodies. Learning how to use EFT is as valuable as learning how to swim before you get tossed off a boat! Learn the skill and teach it to your children. Use it for regular daily stress and then, when a crisis hits, you will have a powerful technique that you can use as needed to reduce suffering and enable you to meet the demands of the situation. EFT can be learned from books, courses, therapists, and self-help videos.

If you happen to be in crisis right now, you can use a brief tapping routine to start with. Here’s how: Focus your attention on one bad feeling (e.g., sadness or worry). Rate the intensity of your emotion from one to ten, where ten is the highest. Take two fingers of each hand and continue to focus your attention on the distressed feeling while tapping lightly under your eyebrows, very close to the bridge of your nose. Continue to focus on the negative feeling while tapping on the outer corners of your eyes. Stay with it while you tap on the bone under your eyes. Finally tap just below each collarbone. Take a deep breath in and slowly blow it out through your mouth. Think about the feeling again and rate its intensity. If your feelings have changed, rate the intensity for the new emotion. Continue doing rounds of tapping until you rate yourself at zero (yes, you CAN get there!).

One of the hardest parts of dealing with a crisis is often the unexpected nature of the situation. Ironically, however, we can all expect to experience a crisis from time to time, since it’s a natural part of the living experience. Being prepared for it by learning and using simple tools doesn’t remove this very hard part of life, but it does help us navigate it more successfully.

(Originally featured in Family First, Issue 845)

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Mindfulness music is a genre of music that is specifically designed to promote relaxation and reduce stress. It typically features slow, soothing melodies, gentle rhythms, and natural sounds such as ocean waves, rain, or birdsong. The aim of mindfulness music is to help you focus your attention on the present moment, rather than getting lost in your thoughts and worries.

Here are some reasons why mindfulness music should be a part of your daily routine:

1. It helps you relax and unwind

One of the primary benefits of mindfulness music is that it helps you relax and unwind. When you listen to this type of music, your body naturally begins to slow down, your heart rate decreases, and your breathing becomes deeper and more rhythmic. This physical relaxation can help to reduce feelings of stress and anxiety, which in turn can improve your overall mood and wellbeing.

2. It improves your focus and concentration

Another key benefit of mindfulness music is that it can improve your focus and concentration. When you’re listening to soothing music, you’re less likely to get distracted by external stimuli or racing thoughts. This can help you stay focused on the task at hand, whether it’s work, studying, or simply enjoying some quiet time alone.

3. It promotes better sleep

If you struggle with insomnia or have trouble falling asleep at night, mindfulness music could be the solution you’ve been looking for. Listening to calming music before bed can help to slow down your mind and body, making it easier to fall asleep and stay asleep throughout the night. In fact, many people find that they sleep more soundly and wake up feeling more refreshed after listening to mindfulness music.

4. It can reduce physical pain

Studies have shown that mindfulness music can also be effective in reducing physical pain. By promoting relaxation and reducing stress levels, calming music can help to alleviate symptoms of chronic pain, headaches, and other physical ailments. It’s not a replacement for medical treatment, but it can be a helpful complementary therapy.

In conclusion, incorporating mindfulness music into your daily routine is a simple and effective way to improve your overall health and wellbeing. Whether you’re looking to reduce stress, improve your focus, or get better sleep, there’s a mindfulness music playlist out there that’s perfect for you. So why not give it a try and see how it can benefit you?

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Mindfulness colouring books have become increasingly popular in recent years, and for good reason. These books are designed to help individuals focus on the present moment and reduce stress and anxiety. They provide a simple and relaxing activity that can be done anywhere and at any time.

One of the benefits of mindfulness colouring books is that they allow individuals to disconnect from technology and other distractions. In a world where we are constantly connected to our phones and other devices, it’s important to take a break and focus on something else. Colouring provides a way to do just that.

Colouring also allows individuals to tap into their creativity. For some people, creativity may not come naturally, but through colouring, they can express themselves in a different way. It’s a way to explore one’s artistic side without the pressure of creating something from scratch.

Moreover, mindfulness colouring books can be a great way to practice meditation. The act of colouring requires focus and attention, which can help individuals achieve a meditative state. It’s a way to calm the mind and reduce stress and anxiety.

In addition, mindfulness colouring books are a great way to practice self-care without breaking the bank. They are affordable and can be done at home, making it easy for individuals to incorporate them into their self-care routine.

Lastly, mindfulness colouring books are a great way to improve cognitive function. Colouring requires the use of both the left and right sides of the brain, helping to improve coordination, concentration, and fine motor skills. It’s a way to keep the brain active and engaged.

In conclusion, mindfulness colouring books are a simple and effective way to practice self-care. They provide a way to disconnect from technology and other distractions, tap into creativity, practice meditation, improve cognitive function, and reduce stress and anxiety. By incorporating mindfulness colouring books into your self-care routine, you can improve your overall well-being and lead a happier and healthier life.

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